Committee opinion no. 619: Gynecologic surgery in the obese woman.

Obesity is a serious problem worldwide and particularly in the United States, and in women is associated with an increased risk of death and morbid conditions (including hypertension, diabetes mellitus, obstructive sleep apnea, and hypercholesterolemia) as well as malignancies such as endometrial and postmenopausal breast cancer. Adverse effects after gynecologic surgery, such as surgical site infection, venous thromboembolism, and wound complications, are more prevalent in obese women than in normal-weight women. Preoperative consultation with an anesthesiologist should be considered for the obese patient in whom the possibility of obstructive sleep apnea is suspected on clinical grounds or who is at risk of coronary artery disease, has a difficult airway, or has poorly controlled hypertension. Gynecologic surgeons should have the knowledge to counsel obese women on the risks specific to this group. As with all patients, evidence demonstrates that, in general, vaginal hysterectomy is associated with better outcomes and fewer complications than laparoscopic or abdominal hysterectomy. Postoperative care of the obese patient is similar to postoperative care of the normalweight patient and comorbid conditions should be taken into consideration.